Bill Text: IA HF2542 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to the practice and licensure of physician assistants, and including effective date provisions. (Formerly HSB 702.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2020-03-11 - Withdrawn. H.J. 587. [HF2542 Detail]
Download: Iowa-2019-HF2542-Introduced.html
House
File
2542
-
Introduced
HOUSE
FILE
2542
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HSB
702)
(COMPANION
TO
SF
2357
BY
COMMITTEE
ON
STATE
GOVERNMENT)
A
BILL
FOR
An
Act
relating
to
the
practice
and
licensure
of
physician
1
assistants,
and
including
effective
date
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
Section
147.107,
subsections
3,
4,
and
5,
Code
1
2020,
are
amended
to
read
as
follows:
2
3.
A
physician
assistant
or
registered
nurse
may
supply,
3
when
pharmacist
services
are
not
reasonably
available
or
when
4
it
is
in
the
best
interests
of
the
patient,
on
the
direct
5
order
of
the
supervising
physician,
a
quantity
of
properly
6
packaged
and
labeled
prescription
drugs,
controlled
substances,
7
or
contraceptive
devices
necessary
to
complete
a
course
of
8
therapy.
However,
a
remote
clinic,
staffed
by
a
physician
9
assistant
or
registered
nurse,
where
pharmacy
services
are
10
not
reasonably
available,
shall
secure
the
regular
advice
11
and
consultation
of
a
pharmacist
regarding
the
distribution,
12
storage,
and
appropriate
use
of
such
drugs,
substances,
and
13
devices.
14
4.
Notwithstanding
subsection
3
,
a
A
physician
assistant
15
shall
not
may
prescribe,
dispense
,
order,
administer,
or
16
procure
prescription
drugs
as
an
incident
to
the
practice
17
of
the
supervising
physician
or
the
physician
assistant,
18
but
may
supply,
when
pharmacist
services
are
not
reasonably
19
available,
or
when
it
is
in
the
best
interests
of
the
patient,
20
a
quantity
of
properly
packaged
and
labeled
prescription
21
drugs
,
controlled
substances,
or
medical
devices
necessary
22
to
complete
a
course
of
therapy
.
However,
a
remote
clinic,
23
staffed
by
a
physician
assistant,
where
pharmacy
services
are
24
not
reasonably
available,
shall
secure
the
regular
advice
25
and
consultation
of
a
pharmacist
regarding
the
distribution,
26
storage,
and
appropriate
use
of
such
drugs,
substances,
and
27
devices.
Prescription
drugs
supplied
under
the
provisions
28
of
this
subsection
shall
be
supplied
for
the
purpose
of
29
accommodating
the
patient
and
shall
not
be
sold
for
more
than
30
the
cost
of
the
drug
and
reasonable
overhead
costs,
as
they
31
relate
to
supplying
prescription
drugs
to
the
patient,
and
32
not
at
a
profit
to
the
physician
or
the
physician
assistant.
33
If
prescription
drug
supplying
authority
is
delegated
by
a
34
supervising
physician
to
a
physician
assistant,
a
nurse
or
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staff
assistant
may
assist
the
physician
assistant
in
providing
1
that
service.
Rules
shall
be
adopted
by
the
board
of
physician
2
assistants,
after
consultation
with
the
board
of
pharmacy,
to
3
implement
this
subsection
pursuant
to
section
148C.4
.
4
5.
Notwithstanding
subsection
1
and
any
other
provision
5
of
this
section
to
the
contrary,
a
physician
may
delegate
6
the
function
of
prescribing
drugs,
controlled
substances,
7
and
medical
devices
for
which
the
supervising
physician
has
8
sufficient
training
or
experience
to
a
physician
assistant
9
licensed
pursuant
to
chapter
148C
after
the
supervising
10
physician
determines
the
physician
assistant’s
proficiency
11
and
competence
.
When
delegated
prescribing
occurs,
the
12
supervising
physician’s
name
shall
be
used,
recorded,
or
13
otherwise
indicated
in
connection
with
each
individual
14
prescription
so
that
the
individual
who
dispenses
or
15
administers
the
prescription
knows
under
whose
delegated
16
authority
the
physician
assistant
is
prescribing.
Rules
17
relating
to
the
authority
of
physician
assistants
to
prescribe
18
drugs,
controlled
substances,
and
medical
devices
pursuant
to
19
this
subsection
shall
be
adopted
by
the
board
of
physician
20
assistants,
after
consultation
with
the
board
of
medicine
and
21
the
board
of
pharmacy.
However,
the
rules
shall
prohibit
the
22
prescribing
of
schedule
II
controlled
substances
which
are
23
listed
as
depressants
pursuant
to
chapter
124
.
24
Sec.
2.
Section
147.136,
subsection
1,
Code
2020,
is
amended
25
to
read
as
follows:
26
1.
Except
as
otherwise
provided
in
subsection
2
,
in
an
27
action
for
damages
for
personal
injury
against
a
physician
and
28
surgeon,
osteopathic
physician
and
surgeon,
dentist,
podiatric
29
physician,
optometrist,
pharmacist,
chiropractor,
physician
30
assistant,
or
nurse
licensed
to
practice
that
profession
in
31
this
state,
or
against
a
hospital
licensed
for
operation
in
32
this
state,
based
on
the
alleged
negligence
of
the
practitioner
33
in
the
practice
of
the
profession
or
occupation,
or
upon
the
34
alleged
negligence
of
the
hospital
in
patient
care,
in
which
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liability
is
admitted
or
established,
the
damages
awarded
shall
1
not
include
actual
economic
losses
incurred
or
to
be
incurred
2
in
the
future
by
the
claimant
by
reason
of
the
personal
3
injury,
including
but
not
limited
to
the
cost
of
reasonable
and
4
necessary
medical
care,
rehabilitation
services,
and
custodial
5
care,
and
the
loss
of
services
and
loss
of
earned
income,
to
6
the
extent
that
those
losses
are
replaced
or
are
indemnified
by
7
insurance,
or
by
governmental,
employment,
or
service
benefit
8
programs
or
from
any
other
source.
9
Sec.
3.
Section
147.138,
Code
2020,
is
amended
to
read
as
10
follows:
11
147.138
Contingent
fee
of
attorney
reviewed
by
court.
12
In
any
action
for
personal
injury
or
wrongful
death
against
13
any
physician
and
surgeon,
osteopathic
physician
and
surgeon,
14
dentist,
podiatric
physician,
optometrist,
pharmacist,
15
chiropractor
,
physician
assistant,
or
nurse
licensed
under
16
this
chapter
or
against
any
hospital
licensed
under
chapter
17
135B
,
based
upon
the
alleged
negligence
of
the
licensee
in
the
18
practice
of
that
profession
or
occupation,
or
upon
the
alleged
19
negligence
of
the
hospital
in
patient
care,
the
court
shall
20
determine
the
reasonableness
of
any
contingent
fee
arrangement
21
between
the
plaintiff
and
the
plaintiff’s
attorney.
22
Sec.
4.
Section
148C.1,
Code
2020,
is
amended
to
read
as
23
follows:
24
148C.1
Definitions.
25
1.
“Approved
program”
means
a
program
for
the
education
26
of
physician
assistants
which
has
been
accredited
by
the
27
American
medical
association’s
committee
on
allied
health
28
education
and
accreditation
or
its
successor,
by
the
commission
29
on
accreditation
of
allied
health
educational
programs
or
30
its
successor,
or
by
the
accreditation
review
commission
on
31
education
for
the
physician
assistant
or
its
successor
,
or,
if
32
accredited
prior
to
2001,
either
by
the
committee
on
allied
33
health
education
and
accreditation,
or
the
commission
on
34
accreditation
of
allied
health
education
programs
.
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2.
“Board”
means
the
board
of
physician
assistants
created
1
under
chapter
147
.
2
3.
“Collaboration”
means
consultation
with
or
referral
to
3
the
appropriate
physician
or
other
health
care
professional
by
4
a
physician
assistant
as
indicated
by
the
patient’s
condition;
5
the
education,
competencies,
and
experience
of
the
physician
6
assistant;
and
the
standard
of
care.
7
3.
4.
“Department”
means
the
Iowa
department
of
public
8
health.
9
4.
5.
“Licensed
physician
assistant”
or
“licensed
P.A.”
10
means
a
person
who
is
licensed
by
the
board
to
practice
as
11
a
physician
assistant
under
the
supervision
of
one
or
more
12
physicians.
“Supervision”
does
not
require
the
personal
13
presence
of
the
supervising
physician
at
the
place
where
14
medical
services
are
rendered
except
insofar
as
the
personal
15
presence
is
expressly
required
by
this
chapter
or
required
by
16
rules
of
the
board
adopted
pursuant
to
this
chapter
.
17
5.
6.
“Physician”
means
a
person
who
is
currently
licensed
18
in
Iowa
to
practice
medicine
and
surgery
or
osteopathic
19
medicine
and
surgery.
Notwithstanding
this
subsection
,
a
20
physician
supervising
a
physician
assistant
practicing
in
21
a
federal
facility
or
under
federal
authority
shall
not
be
22
required
to
obtain
licensure
beyond
licensure
requirements
23
mandated
by
the
federal
government
for
supervising
physicians.
24
6.
7.
“Physician
assistant”
or
“P.A.”
means
a
person
who
25
has
successfully
completed
an
approved
program
and
passed
an
26
examination
approved
by
the
board
or
is
otherwise
found
by
the
27
board
to
be
qualified
to
perform
medical
services
under
the
28
supervision
of
a
physician
meets
the
qualifications
under
this
29
chapter
and
is
licensed
to
practice
medicine
by
the
board
.
30
7.
“Trainee”
means
a
person
who
is
currently
enrolled
in
an
31
approved
program.
32
8.
“Supervising
physician”
means
a
physician
who
supervises
33
the
medical
services
provided
by
a
physician
assistant
34
consistent
with
the
physician
assistant’s
education,
training,
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or
experience
and
who
accepts
ultimate
responsibility
for
the
1
medical
care
provided
by
the
supervising
physician-physician
2
assistant
team.
3
Sec.
5.
Section
148C.3,
subsections
1
and
3,
Code
2020,
are
4
amended
to
read
as
follows:
5
1.
The
board
shall
adopt
rules
to
govern
the
licensure
of
6
physician
assistants.
An
applicant
for
licensure
shall
submit
7
the
fee
prescribed
by
the
board
and
shall
meet
the
requirements
8
established
by
the
board
with
respect
to
each
of
the
following:
9
a.
Academic
qualifications,
including
evidence
of
graduation
10
from
an
approved
program.
A
physician
assistant
who
is
not
a
11
graduate
of
an
approved
program,
but
who
passed
the
national
12
commission
on
certification
of
physician
assistants’
physician
13
assistant
national
certifying
examination
prior
to
1986,
is
14
exempt
from
this
graduation
requirement.
15
b.
Evidence
of
passing
the
national
commission
on
the
16
certification
of
physician
assistants’
physician
assistant
17
national
certifying
examination
or
an
equivalent
examination
18
approved
by
the
board.
19
c.
Hours
of
continuing
medical
education
necessary
to
become
20
or
remain
licensed.
21
3.
A
licensed
physician
assistant
shall
perform
only
22
those
services
for
which
the
licensed
physician
assistant
is
23
qualified
by
training
or
education
and
which
are
not
prohibited
24
by
the
board.
25
Sec.
6.
Section
148C.4,
subsection
1,
Code
2020,
is
amended
26
to
read
as
follows:
27
1.
A
physician
assistant
may
perform
medical
services
28
when
the
services
are
rendered
under
the
supervision
of
a
29
physician.
A
physician
assistant
student
may
perform
medical
30
services
when
the
services
are
rendered
within
the
scope
of
an
31
approved
program
provide
any
legal
medical
service
for
which
32
the
physician
assistant
has
been
prepared
by
the
physician
33
assistant’s
education,
training,
or
experience
and
is
competent
34
to
perform
.
For
the
purposes
of
this
section
,
“medical
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services
when
the
services
are
rendered
under
the
supervision
1
of
a
physician”
“legal
medical
service
for
which
the
physician
2
assistant
has
been
prepared
by
the
physician
assistant’s
3
education,
training,
or
experience
and
is
competent
to
perform”
4
includes
making
a
pronouncement
of
death
for
a
patient
5
whose
death
is
anticipated
if
the
death
occurs
in
a
licensed
6
hospital,
a
licensed
health
care
facility,
a
correctional
7
institution
listed
in
section
904.102
,
a
Medicare-certified
8
home
health
agency,
or
a
Medicare-certified
hospice
program
9
or
facility
,
with
notice
of
the
death
to
a
physician
and
in
10
accordance
with
the
directions
of
a
physician
.
11
Sec.
7.
Section
148C.4,
Code
2020,
is
amended
by
adding
the
12
following
new
subsection:
13
NEW
SUBSECTION
.
3.
The
degree
of
collaboration
between
14
a
physician
assistant
and
the
appropriate
member
of
a
health
15
care
team
shall
be
determined
at
the
practice
level,
and
may
16
involve
decisions
made
by
the
medical
group,
hospital
service,
17
supervising
physician,
or
employer
of
the
physician
assistant,
18
or
the
credentialing
and
privileging
system
of
a
licensed
19
health
care
facility.
A
physician
shall
be
accessible
at
all
20
times
for
consultation
with
a
physician
assistant
unless
the
21
physician
assistant
is
providing
emergency
medical
services
22
pursuant
to
645
IAC
327.1(1)(n).
The
supervising
physician
23
shall
have
ultimate
responsibility
for
determining
the
medical
24
care
provided
by
the
supervising
physician-physician
assistant
25
team.
26
Sec.
8.
Section
249A.4,
subsection
7,
paragraph
b,
Code
27
2020,
is
amended
to
read
as
follows:
28
b.
Advanced
registered
nurse
practitioners
licensed
pursuant
29
to
chapter
152
and
physician
assistants
licensed
pursuant
to
30
chapter
148C
shall
be
regarded
as
approved
providers
of
health
31
care
services,
including
primary
care,
for
purposes
of
managed
32
care
or
prepaid
services
contracts
under
the
medical
assistance
33
program.
This
paragraph
shall
not
be
construed
to
expand
the
34
scope
of
practice
of
an
advanced
registered
nurse
practitioner
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pursuant
to
chapter
152
or
physician
assistants
pursuant
to
1
chapter
148C
.
2
Sec.
9.
ADMINISTRATIVE
RULEMAKING.
3
1.
The
board
of
medicine
and
the
board
of
physician
4
assistants
shall
each,
at
the
next
meeting
of
the
respective
5
boards
held
one
calendar
week
or
more
after
the
enactment
of
6
this
Act,
approve
a
notice
of
intended
action
to
adopt
rules
to
7
implement
this
Act
for
submission
to
the
administrative
rules
8
coordinator
and
the
Iowa
administrative
code
editor
pursuant
to
9
section
17A.4,
subsection
1,
paragraph
“a”.
10
2.
Notwithstanding
section
148C.5,
the
board
of
medicine
11
and
the
board
of
physician
assistants,
in
accordance
with
12
chapter
17A
and
this
section,
and
consistent
with
this
Act,
13
shall
each
amend,
rescind,
or
adopt
rules
which
address
all
of
14
the
following:
15
a.
For
the
board
of
physician
assistants,
rules
relating
to
16
and
in
substantial
conformance
with
all
of
the
following:
17
(1)
Definitions
pursuant
to
645
IAC
326.1
including
all
of
18
the
following:
19
(a)
“Approved
program”
means
a
program
for
the
education
20
of
physician
assistants
which
has
been
accredited
by
the
21
accreditation
review
commission
on
education
for
the
physician
22
assistant
or
its
successor,
or
if
accredited
prior
to
2001,
23
either
by
the
committee
on
allied
health
education
and
24
accreditation,
or
the
commission
on
accreditation
of
allied
25
health
education
programs.
26
(b)
“Collaboration”
means
consultation
with
or
referral
to
27
the
appropriate
physician
or
other
health
care
professional
by
28
a
physician
assistant
as
indicated
by
the
patient’s
condition;
29
the
education,
competencies,
and
experience
of
the
physician
30
assistant;
and
the
standard
of
care.
31
(c)
“Opioid”
means
a
drug
that
produces
an
agonist
effect
32
on
opioid
receptors
and
is
indicated
or
used
for
the
treatment
33
of
pain
or
opioid
use
disorder.
34
(d)
“Physician
assistant”
or
“P.A.”
means
a
person
licensed
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as
a
physician
assistant
by
the
board.
1
(e)
“Remote
medical
site”
means
a
medical
clinic
for
2
ambulatory
patients
which
is
more
than
thirty
miles
away
from
3
the
main
practice
location
of
a
supervising
physician
and
4
in
which
a
supervising
physician
is
present
less
than
fifty
5
percent
of
the
time
the
site
is
open.
“Remote
medical
site”
6
does
not
apply
to
nursing
homes,
patient
homes,
hospital
7
outpatient
departments,
outreach
clinics,
or
any
location
at
8
which
medical
care
is
incidentally
provided
such
as
a
diet
9
center,
free
clinic,
site
for
athletic
physicals,
or
a
jail
10
facility.
11
(f)
“Supervising
physician”
means
a
physician
who
12
supervises
the
medical
services
provided
by
the
physician
13
assistant
consistent
with
the
physician
assistant’s
education,
14
training,
or
experience
and
who
accepts
ultimate
responsibility
15
for
the
medical
care
provided
by
the
physician-physician
16
assistant
team.
17
(2)
Examination
requirements
pursuant
to
645
IAC
326.6
18
including
that
the
applicant
for
licensure
as
a
physician
19
assistant
shall
successfully
pass
the
certifying
examination
20
conducted
by
the
national
commission
on
certification
of
21
physician
assistants
or
a
successor
examination
approved
by
the
22
board
of
physician
assistants.
23
(3)
Use
of
title
requirements
pursuant
to
645
IAC
326.15
24
including
that
a
physician
assistant
licensed
under
chapter
25
148C
may
use
the
words
“physician
assistant”
after
the
person’s
26
name
or
signify
the
same
by
the
use
of
the
letters
“P.A.”
A
27
person
who
meets
the
qualifications
for
licensure
under
chapter
28
148C
but
does
not
possess
a
current
license
may
use
the
title
29
“P.A.”
or
“physician
assistant”
but
may
not
act
or
practice
as
30
a
physician
assistant
unless
licensed
under
chapter
148C.
31
(4)
Recognition
of
an
approved
program
pursuant
to
645
32
IAC
326.18
including
that
the
board
shall
recognize
a
program
33
for
education
and
training
of
physician
assistants
if
it
is
34
accredited
by
the
accreditation
review
commission
on
education
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for
the
physician
assistant
or
its
successor,
or,
if
accredited
1
prior
to
2001,
either
by
the
committee
on
allied
health
2
education
and
accreditation
or
the
commission
on
accreditation
3
of
allied
health
educational
programs.
4
(5)
Duties
pursuant
to
645
IAC
327.1(1),
unnumbered
5
paragraph
1,
including
that
the
medical
services
to
be
6
provided
by
the
physician
assistant
are
those
for
which
the
7
physician
assistant
has
been
prepared
by
education,
training,
8
or
experience
and
is
competent
to
perform.
The
ultimate
9
role
of
the
physician
assistant
cannot
be
rigidly
defined
10
because
of
the
variations
in
practice
requirements
due
to
11
geographic,
economic,
and
sociologic
factors.
The
high
degree
12
of
responsibility
a
physician
assistant
may
assume
requires
13
that,
at
the
conclusion
of
formal
education,
the
physician
14
assistant
possess
the
knowledge,
skills,
and
abilities
15
necessary
to
provide
those
services
appropriate
to
the
practice
16
setting.
The
physician
assistant’s
services
may
be
utilized
in
17
any
clinical
settings
including
but
not
limited
to
the
office,
18
the
ambulatory
clinic,
the
hospital,
the
patient’s
home,
19
extended
care
facilities,
and
nursing
homes.
Diagnostic
and
20
therapeutic
medical
tasks
for
which
the
supervising
physician
21
has
sufficient
training
or
experience
may
be
delegated
to
the
22
physician
assistant
after
a
supervising
physician
determines
23
the
physician
assistant’s
proficiency
and
competence.
24
(6)
Duties
pursuant
to
645
IAC
327.1
relating
to
25
prescribing,
dispensing,
ordering,
administering,
and
procuring
26
drugs
and
medical
devices
including
all
of
the
following:
27
(a)
A
physician
assistant
may
administer
any
drug.
28
(b)
A
physician
assistant
may
prescribe,
dispense,
29
order,
administer,
and
procure
drugs
and
medical
devices.
A
30
physician
assistant
may
plan
and
initiate
a
therapeutic
regimen
31
that
includes
ordering
and
prescribing
nonpharmacological
32
interventions,
including
but
not
limited
to
durable
medical
33
equipment,
nutrition,
blood
and
blood
products,
and
diagnostic
34
support
services
including
but
not
limited
to
home
health
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care,
hospice,
and
physical
and
occupational
therapy.
The
1
prescribing
and
dispensing
of
drugs
may
include
schedule
II
2
through
V
substances
as
described
in
chapter
124
and
all
legend
3
drugs.
4
(c)
A
physician
assistant
may
prescribe
drugs
and
medical
5
devices
subject
to
all
the
following
conditions:
6
(i)
The
physician
assistant
shall
have
passed
the
national
7
certifying
examination
conducted
by
the
national
commission
8
on
the
certification
of
physician
assistants
or
its
successor
9
examination
approved
by
the
board.
Physician
assistants
with
a
10
temporary
license
may
order
drugs
and
medical
devices
only
with
11
the
prior
approval
and
direction
of
a
supervising
physician.
12
Prior
approval
may
include
discussion
of
the
specific
medical
13
problems
with
a
supervising
physician
prior
to
the
patient
14
being
seen
by
the
physician
assistant.
15
(ii)
The
physician
assistant
must
comply
with
appropriate
16
federal
and
state
regulations.
17
(iii)
If
a
physician
assistant
prescribes
or
dispenses
18
controlled
substances,
the
physician
assistant
must
register
19
with
the
federal
drug
enforcement
administration.
20
(iv)
The
physician
assistant
may
prescribe
or
order
21
schedule
II
controlled
substances
which
are
listed
as
22
depressants
in
chapter
124
only
with
the
prior
approval
23
and
direction
of
a
supervising
physician
who
has
sufficient
24
training
or
experience.
Prior
approval
may
include
discussion
25
of
the
specific
medical
problems
with
a
supervising
physician
26
prior
to
the
patient
being
seen
by
the
physician
assistant.
27
(v)
A
physician
assistant
shall
not
prescribe
substances
28
that
the
supervising
physician
does
not
have
the
authority
29
to
prescribe
except
as
allowed
in
645
IAC
327.1(1)(n)
when
30
providing
immediate
evaluation,
treatment,
and
institution
of
31
procedures
essential
to
providing
an
appropriate
response
to
32
emergency
medical
problems.
33
(vi)
The
physician
assistant
may
prescribe,
supply,
and
34
administer
drugs
and
medical
devices
in
all
settings
including
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but
not
limited
to
hospitals,
health
care
facilities,
health
1
care
institutions,
clinics,
offices,
health
maintenance
2
organizations,
and
outpatient
and
emergency
care
settings.
3
(vii)
A
physician
assistant
may
request,
receive,
and
4
supply
sample
drugs
and
medical
devices.
5
(viii)
The
board
of
physician
assistants
shall
be
the
only
6
board
to
regulate
the
practice
of
physician
assistants
relating
7
to
prescribing
and
supplying
prescription
drugs,
controlled
8
substances,
and
medical
devices.
9
(d)
A
physician
assistant
may
supply
properly
packaged
and
10
labeled
prescription
drugs,
controlled
substances,
or
medical
11
devices
when
pharmacist
services
are
not
reasonably
available
12
or
when
it
is
in
the
best
interests
of
the
patient.
13
(i)
When
the
physician
assistant
is
the
prescriber
of
the
14
medications
supplied,
these
medications
shall
be
supplied
for
15
the
purpose
of
accommodating
the
patient
and
shall
not
be
sold
16
for
more
than
the
cost
of
the
drug
and
reasonable
overhead
17
costs
as
they
relate
to
supplying
prescription
drugs
to
the
18
patient
and
not
at
a
profit
to
the
physician
or
physician
19
assistant.
20
(ii)
A
nurse
or
staff
assistant
may
assist
the
physician
21
assistant
in
supplying
medications.
22
(e)
A
physician
assistant
may,
at
the
request
of
the
peace
23
officer,
withdraw
a
specimen
of
blood
from
a
patient
for
24
the
purpose
of
determining
the
alcohol
concentration
or
the
25
presence
of
drugs.
26
(f)
A
physician
assistant
may
direct
medical
personnel,
27
health
professionals,
and
others
involved
in
caring
for
28
patients
and
the
execution
of
patient
care.
29
(g)
A
physician
assistant
may
authenticate
medical
forms
by
30
signing
the
form.
31
(h)
A
physician
assistant
may
perform
other
duties
as
32
appropriate
to
a
physician
assistant’s
practice.
33
(i)
Health
care
providers
shall
consider
the
instructions
34
of
a
physician
assistant
to
be
authoritative.
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(7)
Remote
medical
site
requirements
pursuant
to
645
IAC
1
327.4(1)
and
(2),
including
all
of
the
following:
2
(a)
A
physician
assistant
may
provide
medical
services
in
a
3
remote
medical
site
if
any
of
the
following
conditions
is
met:
4
(i)
The
physician
assistant
has
a
permanent
license
and
at
5
least
one
year
of
practice
as
a
physician
assistant.
6
(ii)
The
physician
assistant
with
less
than
one
year
of
7
practice
has
a
permanent
license
and
meets
all
of
the
following
8
criteria:
9
(A)
The
physician
assistant
has
practiced
as
a
physician
10
assistant
for
at
least
six
months.
11
(B)
The
physician
assistant
and
supervising
physician
have
12
worked
together
at
the
same
location
for
a
period
of
at
least
13
three
months.
14
(C)
The
supervising
physician
reviews
patient
care
provided
15
by
the
physician
assistant
as
determined
to
be
appropriate
by
16
the
supervising
physician.
17
(D)
The
supervising
physician
reviews
a
representative
18
sample
of
patient
charts
unless
the
medical
record
documents
19
that
direct
consultation
with
the
supervising
physician
20
occurred
for
a
period
the
supervising
physician
determines
is
21
appropriate.
22
(iii)
The
physician
assistant
and
supervising
physician
23
provide
a
written
statement
sent
directly
to
the
board
that
24
the
physician
assistant
is
qualified
to
provide
the
needed
25
medical
services
and
that
the
medical
care
will
be
unavailable
26
at
the
remote
site
unless
the
physician
assistant
is
allowed
to
27
practice
there.
In
addition,
for
three
months,
the
supervising
28
physician
must
review
a
representative
sample
of
patient
charts
29
for
patient
care
provided
by
the
physician
assistant
at
least
30
weekly.
31
(b)
The
supervising
physician
must
visit
a
remote
site
32
or
communicate
with
the
physician
assistant
at
the
remote
33
site
via
electronic
communications
to
provide
additional
34
medical
direction,
medical
services,
and
consultation
at
least
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every
two
weeks.
For
purposes
of
this
rule,
communication
1
may
consist
of,
but
shall
not
be
limited
to,
in-person
2
meetings,
two-way
interactive
communication
directly
between
3
the
supervising
physician
and
the
physician
assistant
via
4
telephone,
secure
messaging,
electronic
mail,
or
chart
review.
5
(8)
Identification
as
a
physician
assistant
pursuant
to
6
645
IAC
327.5
including
that
the
physician
assistant
shall
be
7
identified
as
a
physician
assistant
to
patients
and
to
the
8
public,
regardless
of
their
educational
degree.
9
(9)
Prescription
requirements
pursuant
to
645
IAC
327.6(2)
10
including
that
each
oral
prescription
drug
order
issued
by
a
11
physician
assistant
shall
include
the
same
information
required
12
for
a
written
prescription,
except
for
the
written
signature
of
13
the
physician
assistant
and
the
physician
assistant’s
practice
14
address.
15
(10)
Grounds
for
discipline
pursuant
to
645
IAC
329.2(25)
16
including
prohibiting
a
person
from
representing
the
person
17
as
a
physician
assistant
when
the
persons’s
license
has
been
18
suspended
or
revoked,
or
when
the
person’s
license
is
on
19
inactive
status
except
as
provided
by
645
IAC
326.15.
20
b.
For
the
board
of
medicine
rules
relating
to
and
in
21
substantial
conformance
with
the
following
relating
to
22
supervisory
agreements
pursuant
to
653
IAC
21.4
including
all
23
of
the
following:
24
(1)
A
physician
who
supervises
a
physician
assistant
25
shall
establish
a
written
supervisory
agreement
prior
to
26
supervising
a
physician
assistant.
A
sample
supervisory
27
agreement
form
is
available
from
the
board.
The
purpose
of
28
the
supervisory
agreement
is
to
define
the
nature
and
extent
29
of
the
supervisory
relationship
and
the
expectations
of
each
30
party.
The
supervisory
agreement
shall
take
into
account
31
the
physician
assistant’s
demonstrated
skills,
training
and
32
experience,
proximity
of
the
supervising
physician
to
the
33
physician
assistant,
and
the
nature
and
scope
of
the
medical
34
practice.
The
supervising
physician
shall
maintain
a
copy
of
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the
supervisory
agreement
and
provide
a
copy
of
the
agreement
1
to
the
board
upon
request.
The
supervisory
agreement
shall,
at
2
a
minimum,
address
all
of
the
following
provisions:
3
(a)
Review
of
requirements.
The
supervising
physician
and
4
the
physician
assistant
shall
review
all
of
the
requirements
5
of
physician
assistant
licensure,
practice,
supervision,
and
6
delegation
of
medical
services
as
set
forth
in
section
148.13
7
and
chapter
148C,
Iowa
administrative
code
chapter
653,
and
645
8
IAC
chapters
326
to
329.
9
(b)
Assessment
of
education,
training,
skills,
and
10
experience.
Each
supervising
physician
shall
assess
the
11
education,
training,
skills,
and
relevant
experience
of
the
12
physician
assistant
prior
to
providing
supervision.
Each
13
supervising
physician
and
physician
assistant
shall
ensure
14
that
the
other
party
has
the
appropriate
education,
training,
15
skills,
and
relevant
experience
necessary
to
successfully
16
collaborate
on
patient
care
delivered
by
the
team.
The
method
17
for
assessing
and
providing
feedback
regarding
the
physician
18
assistant’s
education,
training,
skills,
and
experience
shall
19
be
reflected
in
the
supervision
agreement.
20
(2)
The
supervision
agreement
between
the
physician
21
assistant
and
the
physician
shall
address
all
of
the
following:
22
(a)
The
medical
services
the
supervising
physician
23
delegates
to
the
physician
assistant.
The
medical
services
24
and
medical
tasks
delegated
to
and
provided
by
the
physician
25
assistant
shall
be
in
compliance
with
645
IAC
327.1(1).
26
All
delegated
medical
services
shall
be
within
the
scope
27
of
practice
of
the
supervising
physician
and
the
physician
28
assistant.
29
(b)
Methods
for
communication
between
the
physician
30
assistant
and
the
physician
and
whether
the
physician
assistant
31
practices
at
the
same
site
or
a
remote
site.
Each
supervising
32
physician
and
physician
assistant
shall
conduct
ongoing
33
discussions
and
evaluation
of
the
supervisory
agreement,
34
including
supervision;
expectations
for
both
parties;
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assessment
of
education,
training,
skills,
and
relevant
1
experience;
review
of
delegated
services;
review
of
the
medical
2
services
provided
by
the
physician
assistant;
and
the
types
of
3
cases
and
situations
when
the
supervising
physician
expects
to
4
be
consulted.
5
(i)
The
plan
for
completing
and
documenting
chart
reviews.
6
A
licensed
physician
within
the
same
facility
or
health
care
7
system
as
the
physician
assistant
shall
conduct
an
ongoing
8
review
of
a
representative
sample
of
the
physician
assistant’s
9
patient
charts
encompassing
the
scope
of
the
physician
10
assistant’s
practice.
The
findings
of
the
review
shall
be
11
discussed
with
the
physician
assistant
in
a
manner
determined
12
by
the
practice
in
consultation
with
the
physician
assistant’s
13
primary
supervising
physician.
14
(ii)
Remote
medical
site.
“Remote
medical
site”
means
15
a
medical
clinic
for
ambulatory
patients
which
is
more
than
16
thirty
miles
away
from
the
main
practice
location
of
the
17
supervising
physician
and
in
which
the
supervising
physician
18
is
present
less
than
fifty
percent
of
the
time
when
the
remote
19
medical
site
is
open.
“Remote
medical
site”
does
not
apply
to
20
nursing
homes,
patient
homes,
hospital
outpatient
departments,
21
outreach
clinics,
or
any
location
at
which
medical
care
is
22
incidentally
provided,
such
as
a
diet
center,
free
clinic,
site
23
for
athletic
physicals,
or
a
jail
facility.
The
supervisory
24
agreement
shall
include
a
provision
which
ensures
that
the
25
supervising
physician
visits
the
remote
medical
site,
or
26
communicates
with
a
physician
assistant
at
the
remote
medical
27
site
via
electronic
communications,
at
least
every
two
weeks
28
to
provide
additional
medical
direction,
medical
services,
29
and
consultation
specific
to
the
medical
services
provided
at
30
the
remote
medical
site.
For
purposes
of
this
subparagraph
31
subdivision,
communication
may
consist
of,
but
shall
not
32
be
limited
to,
in-person
meetings
or
two-way,
interactive
33
communication
directly
between
the
supervising
physician
and
34
the
physician
assistant
via
telephone,
secure
messaging,
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electronic
mail,
or
chart
review.
The
board
shall
only
1
grant
a
waiver
or
variance
of
this
provision
if
substantially
2
equal
protection
of
public
health,
safety,
and
welfare
will
3
be
afforded
by
a
means
other
than
that
prescribed
in
this
4
subparagraph
subdivision.
5
(iii)
The
expectations
and
plan
for
alternate
supervision.
6
The
supervising
physician
shall
ensure
that
the
alternate
7
supervising
physician
is
available
for
a
timely
consultation
8
and
shall
ensure
that
the
physician
assistant
is
notified
9
of
the
means
by
which
to
reach
the
alternate
supervising
10
physician.
11
Sec.
10.
RESCISSION
OF
ADMINISTRATIVE
RULES.
12
1.
The
board
of
physician
assistants
shall
rescind
all
of
13
the
following:
14
a.
645
Iowa
administrative
code,
rule
326.19,
subrule
(3),
15
paragraph
“b”,
subparagraph
(3).
16
b.
645
Iowa
administrative
code,
rule
327.1,
subrule
(1),
17
paragraphs
“r”
through
“z”.
18
c.
645
Iowa
administrative
code,
rule
327.4,
subrules
(1)
19
and
(2).
20
2.
The
board
of
medicine
shall
rescind
653
Iowa
21
administrative
code,
rule
21.4,
subrules
(3)
through
(7).
22
Sec.
11.
RULEMAKING
——
LIMITATION
ON
AMENDMENTS
——
23
CONSTRUCTION.
24
1.
The
board
of
medicine
and
the
board
of
physician
25
assistants,
upon
the
adoption
of
rules
pursuant
to
chapter
17A
26
as
required
by
sections
100
and
101
of
this
Act,
shall
not
27
thereafter
approve
a
notice
of
intended
action
pursuant
to
28
section
17A.4,
subsection
1,
paragraph
“a”,
for
the
amendment
29
or
rescission
of
such
rules
for
a
period
of
two
years
from
the
30
effective
date
of
this
Act.
31
2.
Except
as
provided
in
subsection
1,
the
rulemaking
32
requirements
provided
in
sections
100
and
101
of
this
Act
shall
33
not
be
construed
to
prohibit
the
board
of
medicine
or
the
board
34
of
physician
assistants
from
engaging
in
further
rulemaking
not
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in
conflict
with
sections
100
or
101
of
this
Act
relating
to
1
the
subject
matter
of
those
sections
or
to
otherwise
diminish
2
the
authority
to
engage
in
rulemaking
provided
to
either
board
3
by
section
147.76
or
any
other
statute.
4
Sec.
12.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
5
immediate
importance,
takes
effect
upon
enactment.
6
EXPLANATION
7
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
8
the
explanation’s
substance
by
the
members
of
the
general
assembly.
9
This
bill
relates
to
the
practice
and
licensure
of
physician
10
assistants.
11
With
regard
to
drug
dispensing,
supplying,
and
prescribing,
12
the
bill
provides
that
a
physician
assistant
may
prescribe,
13
dispense,
order,
administer,
or
procure
prescription
drugs,
14
controlled
substances,
or
medical
devices
necessary
to
complete
15
a
course
of
therapy
in
accordance
with
Code
section
148C.4
16
which
provides
that
the
physician
assistant
may
provide
any
17
legal
medical
service
for
which
the
physician
assistant
has
18
been
prepared
by
education,
training,
or
experience
and
is
19
competent
to
perform.
Additionally,
the
bill
provides
that
20
a
physician
may
delegate
the
function
of
prescribing
drugs,
21
controlled
substances,
and
medical
devices
for
which
the
22
supervising
physician
has
sufficient
training
or
experience
23
after
the
supervising
physician
determines
the
physician
24
assistant’s
proficiency
and
competence.
Rules
relating
to
25
the
authority
of
physician
assistants
to
prescribe
drugs,
26
controlled
substances,
and
medical
devices
shall
be
adopted
by
27
the
board
of
physician
assistants,
after
consultation
with
the
28
board
of
medicine
and
the
board
of
pharmacy.
29
The
bill
includes
physician
assistants
in
the
listing
of
30
health
care
providers
in
provisions
relating
to
the
scope
31
of
recovery
in
an
action
for
damages
for
personal
injury,
32
limitations
on
noneconomic
damage
awards
against
health
care
33
providers,
and
contingent
fees
for
attorneys
in
any
action
34
for
personal
injury
or
wrongful
death
against
a
health
care
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provider.
1
The
bill
includes
definitions
for
the
purposes
of
Code
2
chapter
148C
(physician
assistants).
The
bill
amends
the
3
definition
of
“approved
program”
for
the
education
of
physician
4
assistants;
includes
a
definition
of
“collaboration”
and
5
“supervising
physician”,
and
defines
“physician
assistant”
or
6
“P.A.”
as
a
person
who
meets
the
qualifications
under
Code
7
chapter
148C
and
is
licensed
to
practice
medicine
by
the
board
8
of
physician
assistants.
9
The
bill
amends
the
reference
to
a
physician
assistant
10
examination
that
may
be
completed
in
lieu
of
graduation
from
11
an
approved
program,
and
provides
that
a
licensed
physician
12
assistant
shall
perform
only
those
services
for
which
the
13
licensed
physician
assistant
is
qualified
by
training
or
14
education
and
which
are
not
prohibited
by
the
board.
15
The
bill
provides
with
regard
to
the
services
that
may
16
be
performed
by
a
physician
assistant,
that
a
physician
17
assistant
may
provide
any
legal
medical
service
for
which
18
the
physician
assistant
has
been
prepared
by
the
physician
19
assistant’s
education,
training,
or
experience
and
is
competent
20
to
perform.
The
degree
of
collaboration
between
a
physician
21
assistant
and
the
appropriate
member
of
a
health
care
team
22
shall
be
determined
at
the
practice
level,
and
may
involve
23
decisions
made
by
the
medical
group,
hospital
service,
24
supervising
physician,
or
employer
of
the
physician
assistant,
25
or
the
credentialing
and
privileging
system
of
a
licensed
26
health
care
facility.
A
physician
shall
be
accessible
at
all
27
times
for
consultation
with
a
physician
assistant
unless
the
28
physician
assistant
is
providing
emergency
medical
services.
29
The
supervising
physician
shall
have
ultimate
responsibility
30
for
determining
the
medical
care
provided
by
the
supervising
31
physician-physician
assistant
team.
32
The
bill
also
includes
physician
assistants
as
approved
33
providers
of
health
care
services,
including
primary
care
for
34
purposes
of
managed
care
or
prepaid
services
contracts
under
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the
Medicaid
program
and
provides
that
the
provision
shall
not
1
be
construed
to
expand
the
scope
of
practice
of
a
physician
2
assistant.
3
The
bill
also
requires
the
board
of
medicine
and
the
board
4
of
physician
assistants
to
each,
at
the
next
meeting
of
the
5
respective
boards
held
one
calendar
week
or
more
after
the
6
enactment
of
the
bill,
to
approve
a
notice
of
intended
action
7
to
adopt
rules
to
implement
the
bill.
The
bill
specifies
the
8
rules
that
the
two
boards
are
to
address
or
rescind.
The
bill
9
provides
that
the
board
of
medicine
and
the
board
of
physician
10
assistants,
upon
the
adoption
of
rules
pursuant
to
Code
chapter
11
17A
as
required
by
the
bill,
shall
not
thereafter
approve
a
12
notice
of
intended
action
for
the
amendment
or
rescission
of
13
such
rules
for
a
period
of
two
years
from
the
effective
date
14
of
the
bill.
With
the
exception
of
the
two-year
limitation,
15
the
rulemaking
requirements
provided
in
the
bill
shall
not
be
16
construed
to
prohibit
the
board
of
medicine
or
the
board
of
17
physician
assistants
from
engaging
in
further
rulemaking
not
in
18
conflict
with
the
provisions
of
the
bill
relating
to
rulemaking
19
and
to
the
subject
matter
of
those
provisions
of
the
bill
or
20
to
otherwise
diminish
the
authority
to
engage
in
rulemaking
21
provided
to
either
board
by
Code
section
147.76
(rules)
or
any
22
other
statute.
23
The
bill
takes
effect
upon
enactment.
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